I received these handouts while sitting around a waiting room. I tried to scan them but that didn't work... luckily I found it on the net. Nothing in here really struck me as being beneficial but I thought I'd post them in case anyone here finds them useful. They're more like activities...

Distress Tolerance Handouts

Crises Survival Strategies

DISTRACT
(to reduce contact with emotional stimuli )

A useful way to remember these skills is the phrase
Wise Mind ACCEPTS

With ACTIVITIES:
Distress Tolerance helps you to feel better, and as you feel better and productive, your self esteem rises and endorphin’s are released. When you do physical activity, you can get a good feeling because chemicals release when we exert ourselves. Do something physical like exercise, hobbies, cleaning, go to community events, call or visit a friend, play computer games, go walking, work, play, participate in sports, go out to a meal, have decaf coffee or tea, go fishing, chop wood, do gardening, play pinball. Do whatever works for you.

With CONTRIBUTING:
Contribute to someone, do volunteer work; give something to someone else, make something nice for someone else, do a surprising, thoughtful thing.

With COMPARISONS:
Watch disaster movies, watch soap operas, visit an ER waiting room, or a hospital waiting room, compare yourself to people coping the same as you or less well than you.

With EMOTIONS
(Opposite Emotions): Be sure what you do will create the opposite emotion to what you are feeling. You could watch comedies like "I Love Lucy" or "Carol Burnett" or watch emotional movies or listen to emotional music. Read emotional books or stories.

With PUSHING AWAY
(use this skill last - as a tuning out): Push the situation away by leaving it for a while, leave the situation mentally. Build an imaginary wall between yourself and the situation or push the situation away by blocking it out of your mind. Censor ruminating. Refuse to think about the painful aspects of the situation. Put the pain on a shelf. Box it up and put it away for a while.

With THOUGHTS
(other thoughts): Count to 10; count colors in a painting or tree or out the window. Do anything, work puzzles, watch TV, read.

With SENSATIONS
(other intense sensations): Hold ice in your hand, squeeze a rubber ball very hard, take a hot shower, listen to loud music, sex, snap a rubber band on your wrist, suck on a lemon.
SELF SOOTHE

A way to remember these skills is to think of soothing each of your FIVE SENSES

With VISION:
Buy one beautiful flower, make one space in a room pretty, light a candle and watch the flame. Set a pretty place at the table, using your best things for a meal. Go to a museum with beautiful art. Go sit in the lobby of a beautiful old hotel. Look at nature around you. Go out in the middle of the night and watch the stars. Walk in a pretty part of the town. Fix your nails so they look pretty. Look at beautiful pictures in a book. Go to a ballet or other dance performance, or watch one on TV. Be mindful of each sight that passes in front of you, not lingering on any.

With HEARING:
Listen to beautiful or soothing music, or to invigorating and exciting music. Pay attention to sounds of nature like waves, birds rainfall, rustling leaves. Sing your favorite songs, hum a soothing tune, learn to play an instrument. Call 800 or other information numbers to hear a human voice. Be mindful of any sounds that come your way, letting them go in one ear and out the other.

With SMELL:
Use your favorite perfume or lotions, or try them on in the store, spray fragrance in the air, light a scented candle. Put lemon oil on your furniture. Put potpourris in a bowl in your room. Boil cinnamon, bake cookies, cake or bread. Smell the roses. Walk in a wooded area and mindfully breathe in the fresh smells of nature.

With TASTE:
Have a good meal, have a favorite soothing drink, such as herbal tea or hot chocolate (but no alcohol). Treat yourself to a dessert. Put whipped cream on your coffee. Sample flavors at an ice cream store. Suck on a piece of peppermint candy. Chew your favorite gum. Get a little bit of special food you don't usually spend the money on, such as fresh squeezed orange juice or organic vegetables. Really taste the food you eat, eating one thing mindfully and focusing on its taste.

With TOUCH:
Experience whatever you are touching, notice that the touch is soothing. Take a bubble bath, put clean sheets on the bed, pet your dog or cat, have a massage, soak your feet, put creamy lotion on your whole body. Put a cold compress on your forehead, sink into a really comfortable chair in a hotel lobby or in your home, put on a silky blouse, dress, or scarf. Try on fur-lined gloves. Brush your hair for a long time. Hug someone.
IMPROVE THE MOMENT :

A way to remember these skills is in the word IMPROVE

With IMAGERY:
Imagine very relaxing scenes or soldiers fighting and winning. Imagine a secret room within yourself, seeing how it is decorated. Go into the room whenever you feel threatened. Close the door on anything that can hurt you. Imagine everything going well. Imagine coping well. Make up a fantasy world that is calming and beautiful and let your mind go with it. Imagine hurtful emotions draining out of you like water out of a pipe.

With MEANING:
(create a track record of endurance) Find or create some purpose, meaning or value in physical or emotional pain. Remember, listen to, or read about spiritual values. Focus on whatever positive aspects of a painful situation you can find. Repeat them over and over in your mind. Make lemonade out of lemons.

With PRAYER:
(walk & talk out loud or kneel and pray to your higher power, to God, Goddess, whoever) Open your heart to a supreme being with great wisdom, whatever that means to you. It could be God or your own wise mind for instance. Ask for the strength to bear the pain in this moment. Turn things over to God or a higher being.

With RELAXATION:
Find humor and laugh. Try relaxing each large muscle group, starting with your hands and arms, going to the top of your head, and then working down. Listen to a relaxation tape, exercise hard, take a hot bath, or sit in a hot tub. Drink hot milk, massage your neck and scalp, or your calves and feet, get in a tub filled with very cold or hot water and stay in it as long as you can tolerate. Breathe deeply, half-smile, change your facial expression

With ONE THING IN THE MOMENT:
Focus your entire attention on just what you are doing right now. Keep yourself in the very moment you are in in the present. Focus your entire attention on physical sensations that accompany nonjudgmental tasks. (e.g. walking, washing, doing dishes, cleaning, fixing). Be aware of how your body moves during each task. Do awareness exercises.

With VACATION:
Give yourself a brief vacation. For instance, from 2 p.m. to 4 p.m., get in bed and pull the covers over your head for 20 minutes. Rent a motel room at the beach or in the woods for a day or two. Unplug your phone for a day, or let your answering machine screen your calls. Take a 1 hour breather from work that needs to be done. Look at a magazine, bundle up in a chair, eat slowly. Allow yourself to be a kid again - take a break from adulthood.

With ENCOURAGEMENT:
Cheer lead yourself. Repeat over and over: “I can stand it. This won't last forever. I will make it out of this. I'm doing the best I can. I can do it. I am OK.”
Thinking of PROS and CONS

Make a list of the pros and cons of tolerating the distress. Make another list of the pros and cons of not tolerating the distress - that is, of coping by hurting yourself, abusing alcohol, or drugs, or doing something else impulsive. Focus on long-term goals, the light at the end of the tunnel. Remember times when pain has ended. Think of the positive consequences of tolerating the distress. Imagine in your mind how good you will feel if you achieve your goals, if you don't act impulsively. Think of all of the negative consequences of not tolerating your current distress. Remember what has happened in the past when you have acted impulsively to escape the moment. Ask yourself, “Will this event that is distressing me going to matter in 5 years?”



Guidelines for Accepting Reality: Observing Your Breath Exercises

OBSERVING YOUR BREATH:
Focus your attention on your breath, coming in and out.
Observe your breathing as a way to center yourself in your wise mind.
Observe your breathing as a way to take hold of your mind, dropping off non-acceptance and fighting reality.

DEEP BREATHING:
Lie on your back. Breathe evenly and gently, focusing your attention on the movement of your stomach. As you begin to breathe in, allow your stomach to rise in order to bring in air into the lower half of your lungs. As the upper halves of your lungs being to fill with air, your chest begins to rise and your stomach begins to lower. Don't tire yourself. Continue for 10 breaths. The exhalation will be longer than the inhalation.

MEASURING YOUR BREATH BY YOUR FOOTSTEPS:
Walk slowly in a yard, along a sidewalk, or on a path, in a hallway. Breathe normally. Determine the length of your breath, the exhalation and the inhalation, by the number of your footsteps. Continue for a few minutes. Begin to lengthen your exhalation by one step. Do not force a longer exhalation. Let it be natural. Watch your inhalation carefully to see whether there is a desire to lengthen it.
Continue for 10 breaths.
Now lengthen the exhalation by one more footstep. Watch to see whether the inhalation also lengthens by one step or not. Only lengthen the inhalation when you feel that it will give delight. After 20 breaths, return your breath to normal. About 5 minutes later, you can begin the practice of lengthened breaths again. When you feel the least bit tired, return to normal. After several sessions of the practice of lengthened breath, your exhalation and inhalation will grow in equal length.
Do not practice long, equal breaths for more than 10 to 20 breaths before returning to normal.

COUNTING YOUR BREATH:
Sit cross-legged on the floor (sit in the half or full lotus position if you know how); or sit in a chair with your feet on the floor; or kneel or lie flat on the floor, or take a walk.
As you inhale, be aware that "I am inhaling.”
When you exhale, be aware that "I am exhaling."
Remember to breathe from the stomach.
When breathing the second inhalation, be aware that "I am inhaling."
Slowly exhaling, be aware that "I am exhaling."
Continue on up and through 10. After you have reached 10, return to 1.
If you lose count, return to 1.

FOLLOWING YOUR BREATH WHILE LISTENING TO MUSIC:
Listen to a piece of music.
Breathe long, light and even breaths. Follow your breath, be master of it while remaining aware of the movement and sentiments of the music. Do not get lost in the music, but continue to be master of your breath and yourself.

FOLLOWING YOUR BREATH WHILE CARRYING ON A CONVERSATION
Breathe long, light and even breaths. Follow your breath while listening to a friend's words and your own replies. Continue as with the music.

FOLLOWING THE BREATH:
Sit cross-legged on the floor (sit in the half or full lotus position if you know how) or sit in a chair with your feet on the floor, or take a walk.
Begin to inhale gently and normally (from the stomach) aware that “I am inhaling normally."
Exhale in awareness, "I am exhaling normally."
Continue for three breaths.
On the fourth breath, extend the inhalation, aware that "I am breathing out a long exhalation."
Continue for three breaths.
Now follow your breath carefully, aware of every movement of your stomach and lungs. Follow the entrance and exit of air.
Be aware that "I am inhaling and following the inhalation from its beginning to its end.”
“I am exhaling, and following the exhalation from its beginning to its end."
Continue for 20 breaths. Return to normal. After 5 minutes, repeat the exercise.
Maintain a half-smile while breathing. Once you have mastered this exercise, move on to the next.

BREATHING TO QUIET THE MIND AND BODY:

Sit cross-legged on the floor (sit in the half or full lotus position if you know how) or sit in a chair with your feet on the floor, or kneel, or lie flat on the floor. Half smile.
Follow your breath. When your mind and body are quiet, continue to inhale and exhale very lightly.
Be aware that "I am breathing in and making the breath and body light and peaceful. I am exhaling and making the body light and peaceful."
Continue for three breaths, giving rise to the thought, "I am breathing in while my body and mind are at peace. I am breathing out while my body and mind are at peace."
Maintain this thought in awareness from 5 to 30 minutes, according to your ability and to the time available to you.
The beginning and end of the practice should be relaxed and gentle. When you want to stop, gently massage the muscles in your legs before returning to a normal sitting position.
Wait a moment before standing up.

Note: Adapted from the Miracle of Mindfulness: A Manual of Meditation (pp. 81-84) by Thich Nhat Hanh, 1976, Boston, Beacon Press, Copyright 1987 by Mobi Ho. Adapted by permission.

Guidelines for Accepting Reality: Half-Smiling Exercises

Accept reality with your body. Relax (by letting go or by just tensing and then letting go) your face, neck, and shoulder muscles and half-smile with your lips. A tense smile is a grin (and might tell the brain you are hiding or masking). A half-smile is slightly upturned lips with a relaxed face. Try to adopt a serene facial expression. Remember, your body communicates to your mind.

HALF-SMILE WHEN YOU FIRST AWAKE IN THE MORNING
Hang a branch, any other sign, or even the word "smile" on the ceiling or wall so that you see it right away when you open your eyes. This sign will serve as a reminder. Use the seconds before you get out of bed to take hold of your breath. Inhale and exhale three breaths gently while maintaining a half-smile. Follow your breaths.

HALF-SMILE DURING YOUR FREE MOMENTS
Anywhere you find yourself sitting or standing, half smile. Look at a child, a leaf, a painting on a wall, or anything that is relatively still, and smile. Inhale and exhale quietly three times.

HALF-SMILE WHILE LISTENING TO MUSIC
Listen to a piece of music for 2 or 3 minutes. Pay attention to the words, music, rhythm and sentiments of the music you are listening to (not your daydreams of other times). Half smile while watching your inhalations and exhalations.

HALF-SMILE WHEN IRRITATED
When you realize "I'm irritated," half smile at once. Inhale and exhale quietly, maintaining a half-smile for three breaths.

HALF-SMILE IN A LYING-DOWN POSITION
Lie on your back on a flat surface without the support of a mattress or pillow. Keep your two arms loosely by your sides and keep your two legs slightly apart, stretched out before you. Maintain a half-smile. Breathe in and out gently, keeping your attention focused on your breath. Let go of every muscle in your body. Relax each muscle as though it were sinking down through the floor, or as though it were as soft and yielding as a piece of silk hanging in the breeze to dry. Let go entirely, keeping your attention only on your breath and half-smile. Think of yourself as a cat, completely relaxed before a warm fire, whose muscles yield without resistance to anyone's touch. Continue for 15 breaths.

HALF-SMILE IN A SITTING POSITION
Sit on the floor with your back straight, or on a chair with your two feet touching the floor. Half-smile. Inhale and exhale while maintaining the half-smile. Let go.

HALF-SMILE WHILE CONTEMPLATING THE PERSON YOU HATE OR DESPISE THE MOST
Sit quietly. Breathe and smile a half-smile. Imagine the image of the person who has caused you the most suffering. Regard the features you hate or despise the most or find the most repulsive. Try to examine what makes this person happy and what causes suffering in his or her daily life. Imagine the person's perceptions; try to see what patterns of thought and reason this person follows. Examine what motivates this person's hopes and actions. Finally, consider the person's consciousness. See whether the person's views and insights are open and free or not, and whether or not the person has been influenced by any prejudices, narrow-mindedness, hatred, or anger. See whether or not the person is master of himself or herself. Continue until you feel compassion rise in your heart like a well filling with fresh water, and your anger and resentment disappear. Practice this exercise many times on the same person.

Guidelines for Accepting Reality: Awareness Exercises

AWARENESS OF THE POSITIONS OF THE BODY
This can be practiced in anytime and anywhere.
Begin to focus your attention on your breath. Breathe quietly and more deeply than usual. Be mindful of the position of your body, whether you are walking, standing, lying or sitting down.
Know where you walk, stand, lie or sit. Be aware of the purpose of your position. For example, you might be conscious that you are standing on a green hillside in order to refresh yourself, to practice breathing, or just to stand.
If you have no sense of purpose, be aware that there is no purpose.


AWARENESS OF CONNECTION TO THE UNIVERSE
This can be practiced any time, any place.
Focus your attention on where your body touches an object (floor or ground, air molecules, a chair or arm rest, your bed sheets and covers, your clothes, etc.).
Try to see all the ways you are connected to and accepted by that object. Consider the function of that object with relation to you. That is, consider what the object does for you. Consider its kindness in doing that.
Experience the sensation of touching the object and focus your entire attention on that kindness until a sense of being connected or loved or cared for arises in your heart.

Examples:
Focus your attention on your feet touching the ground. Consider the kindness of the ground holding you up, providing a path for you to get to other things, not letting you fall away from everything else.
Focus your attention on your body touching the chair you sit in. Consider how the chair accepts you totally, holds you up, supports your back, keeps you from falling down on the floor.
Focus your attention to the sheets and the covers on your bed. Consider the touch of the sheets and covers holding you, surrounding you and keeping you warm and comfortable.
Consider the walls in the room. They keep out the wind and the cold and the rain. Think of how the walls are connected to you via the floor and the air in the room. Experience your connection to the walls that provide you with a secure place to do things.
Go hug a tree. Think of how you and the tree are connected. Life is in you and in the tree and both of you are warmed by the sun, held by the air and supported by the earth. Try to experience the tree loving you by providing something to lean on, or by shading you.

AWARENESS WHILE MAKING TEA OR COFFEE
Prepare a pot of tea or coffee to serve a guest or to drink by yourself. Do each movement slowly, in awareness. Do not let one detail of your movements go by without being aware of it. Know that your hand lifts the pot by its handle. Know that you are pouring the fragrant, warm tea, or coffee into the cup.
Follow each step in awareness. Breathe gently, and more deeply than usual.
Take hold of your breath if your mind strays.

AWARENESS WHILE WASHING THE DISHES
Wash the dishes consciously, as though each bowl is an object of contemplation. Consider each bowl as sacred.
Follow your breath to prevent your mind from straying.
Do not try to hurry to get the job over with. Consider washing the dishes the most important thing in life.

AWARENESS WHILE HAND-WASHING CLOTHES
Do not wash too many clothes at one time. Select only three or four articles of clothing.
Find the most comfortable position to sit so as to prevent a backache. Scrub the clothes consciously.
Hold your attention on every movement of your hands and arms. Pay attention to the soap and water. When you have finished scrubbing and rinsing, your mind and body will feel as clean and fresh as your clothes.
Remember to maintain a half-smile and take hold of your breath whenever your mind wanders.

AWARENESS WHILE CLEANING THE HOUSE
Divide your work into stages: straightening things and putting away books, scrubbing the toilet, scrubbing the bathroom, sweeping the floor, and dusting.
Allow a good length of time for each task. Move slowly, three times more slowly than usual. Focus your attention fully on each task.
For example, while placing the book on the shelf, look at the book, be aware of what the book is, know that you are in the process of placing it on the shelf and know that you intend to put it in that specific place. Know that your hand reaches for the book, and picks it up.
Avoid any abrupt or harsh movement.
Maintain awareness of the breath, especially when your thoughts wander.

AWARENESS WHILE TAKING A SLOW-MOTION BATH
Allow yourself 30 to 45 minutes to take a bath. Don't hurry for even a second. From the moment you prepare the bath water to the moment you put on clean clothes, let every motion be light and slow.
Be attentive of every moment while you put on clean clothes, let every motion be light and slow. Be attentive of every movement.
Place your attention to every part of your body, without discrimination or fear. Be aware of each stream of water on your body. By the time you've finished, your mind will feel as peaceful and light as your body.
Follow your breath. Think of yourself as being in a clean and fragrant lotus pond in the summer.

PRACTICING AWARENESS WITH MEDITATION
Sit comfortably on the floor with your back straight, or in a chair with both feet touching the floor. Close your eyes all the way, or open them slightly and gaze at something near.
With each breath, say to yourself, quietly and gently, the word "ONE." As you inhale, say the word "ONE." As you exhale, say the word, "ONE", calmly and slowly. Try to collect your whole mind and put it into this one word. When your mind strays, return gently to saying "ONE."
If you start wanting to move, try not to move. Just gently observe wanting to move. Continue practicing a little past wanting to stop. Just gently observe wanting to stop.

Scenario One
Going to work, you are caught by your supervisor coming in 30 minutes late. How will you feel? What DBT skills can you use to help yourself deal with your emotions and cope with the confrontation?

Scenario Two
You are in a family situation, everyone is saying that you should go get a job and that you did not do that because you are lazy. How will you feel? What DBT skills can you use to help yourself deal with your emotions and cope with the confrontation?

Scenario Three
You re in an excellent mood and you like to go shopping, your friends refuse to go shopping with you. How will you feel? What DBT skills can you use to help yourself deal with your emotions and cope with the confrontation?

Scenario Four
You are in the doctor's office, and she refuses to prescribe the sleeping pills because she thinks that you might overdose on it? How will you feel? What DBT skills can you use to help yourself deal with your emotions and cope with the confrontation?

Note: Exercises 1 and 3-8 are adapted from the Miracle of Mindfulness: A Manual of Meditation (pp. 84-87) 1976, Boston, Beacon Press, Copyright 1976 by Thich Nhat Hanh, Adapted by permission.


Basic Principles of Accepting Reality

Accepting reality does not mean you have to like the circumstances. Some tools to help you accept reality are breathing, half smile, awareness.
For Example: Radical Acceptance: I have suicidal thoughts all the time but it doesn't mean I like having them or will act on them.

WILLINGNESS
Cultivate a WILLING response to each situation
Willingness is doing just what is needed in each situation, in an unpretentious way. It is focusing on effectiveness.
Willingness is listening very carefully to your WISE MIND, acting from your inner self.
Willingness is becoming aware of your connection to the universe - to the earth, to the floor you are standing on, to the chair you are sitting on, to the person you are talking to.
Ask yourself, in 5 years from now, will the situation that causes the distress matter?

WILLFULNESS
Willfulness is like sitting on your hands when action is needed, refusing to make changes that are needed.
Willfulness causes you to fight any suggestions that will improve the distress and thus make it more tolerable.
Willfulness is giving up.
It is the opposite of doing what works, of being effective. Willfulness is trying to fix every situation or refusing to tolerate the distressful moment.

TURNING THE MIND
Acceptance of reality requires an act of CHOICE. It is like coming to a fork in the road. You have to turn your mind towards the acceptance road and away form the rejecting reality road.
You have to make an inner COMMITMENT to accept. The commitment to accept does not itself equal acceptance. It just turns you toward the path. But it is the first step.
You have to turn your mind and commit to acceptance OVER AND OVER AND OVER again. Sometimes, you have to make the commitment many times in the space of a few minutes.

RADICAL ACCEPTANCE
Freedom from suffering requires ACCEPTANCE FROM DEEP WITHIN.
It is allowing yourself to go completely with whatever the situation is. Let go of fighting reality.
ACCEPTANCE IS THE ONLY WAY OUT OF HELL WHICH MUST NOT BE INTERPRETED AS APPROVAL OF THE DISTRESSFUL SITUATION
Pain creates suffering only when you refuse to ACCEPT the pain.
Deciding to tolerate the moment is ACCEPTANCE.
ACCEPTANCE is acknowledging what is.
To accept something is not the same as judging it to be good.
By stopping your self from fighting, the rage or anger you feel will dissipate as long as you continue to accept your condition or your faulty perceptions to events or interpersonal communications difficulties. You will be amazed at how much better you will feel when you are able to accept.



Here's the link. There are other exercises and topics listed there

[SanDiegoGirl]

Originally Posted by MadRiverTurtle

I received these handouts while sitting around a waiting room. I tried to scan them but that didn't work... luckily I found it on the net. Nothing in here really struck me as being beneficial but I thought I'd post them in case anyone here finds them useful. They're more like activities...

Wow, MadRiverTurtle, that is one of the best things I have read on this subject in a long time.

I urge others who are facing depression or other mental health symptoms to not only read this, on a regular basis, but to connect with others who are similarly affected. Don't turn inward. Don't be alone.

This time of year we are especially vulnerable.

Much peace and love to all in this community...